Health insurance coverage and unpaid healthcare for full-time workers and their family members without employer coverage cost the U.S. public $45 billion a year, according to a report from The Commonwealth Fund.
The report, "Who Pays for Health Care When Workers Are Uninsured?" by Sherry Glied and Bisundev Mahato at Columbia University, found that 19 million full-time workers and their dependents were uninsured in 2004, compared to 16 million in 1999. The report also found that 11 million workers and their dependents are enrolled in public programs in 2004, up from 6 million in 1999, a 70 percent increase over the five-year period.
The cost borne by the public for workers not covered by their own employers is largely a result of fewer workers and worker family members obtaining health insurance coverage through their employers. This includes $33 billion in the cost of public coverage such as Medicaid and the State Children's Health Insurance Program, and $12 billion in uncompensated care expenses, which are paid by Federal, state and local governments and shifted to other payers, provided to uninsured workers and dependents.
"Without insurance coverage, people don't get the care they need when they are sick, and the preventive care they need to keep them from getting sick in the first place," said lead author Sherry Glied, Professor and Chair of the Department of Health Policy and Management of Columbia University's Mailman School of Public Health. "When private employer-sponsored coverage declines, public health insurance and uncompensated care only fill part of the gap. We need expanded health insurance coverage to ensure that everyone has access to the benefits of healthcare."
According to the report, the costs of publicly paid healthcare for full-time workers and families increased from $31 billion in 1999 to $45 billion in 2004. This includes an increase in public insurance costs from $21.2 billion to $32.5 billion, and an increase in uncompensated care costs from $9.4 billion to $12 billion.
A related study by Glied and Mahato found that in 2003 one-third of full-time workers earning less than the 20th percentile of wages - $9.80 or less per hour in 2003 - were uninsured for the full year, an increase of 9 percentage points since 1996. It also shows a growing divide in the health system between low-wage and higher-wage earners between 1996-2003. While higher-wage workers made substantial gains in their use of preventive care services over the period of the study, lower-wage workers made only modest gains or suffered declines in preventive care.
Both studies concluded that the growing lack of employer provided healthcare is placing a larger burden on taxpayers, working families, especially lower-wage workers, and public health insurance programs.
"If we want to move the United States toward the high performance healthcare system Americans want and deserve, the first step is to get all Americans insured," says Commonwealth Fund President Karen Davis. "In order to do that, the public and private sectors must work together to share responsibility for providing healthcare coverage."